Mode
Text Size
Log in / Sign up

EUS-PPG Shows Strong Correlation With Invasive Portal Pressure, but Agreement Remains WideNew ultrasound method shows strong link to liver pressure levels

AI-generated summary of the cited source, checked by automated accuracy review. How we work

Key Takeaway
Interpret EUS-PPG as promising but not yet a replacement for invasive portal pressure measurement.

This meta-analysis pooled 6 prospective cohorts comprising 127 attempted EUS-guided portal pressure gradient (EUS-PPG) procedures to assess correlation with invasive hemodynamic measurements. The authors report strong associations between EUS-PPG and both hepatic venous pressure gradient (HVPG) (0.82; 95% CI, 0.72-0.89; I=0%) and direct portal venous pressure (0.86; 95% CI, 0.72-0.93; I=16.9%). Technical success was 95.3%. Adverse events occurred in 2.4% of procedures, with no procedure-related deaths reported.

Despite the strong correlations, agreement between EUS-based and invasive measurements was limited. The limits of agreement were wide, approximately -6 to +7 mmHg. Threshold discordance of 5 mmHg or greater was observed in 4 out of 30 cases where this was assessed. These findings suggest that while EUS-PPG tracks with invasive pressures at the population level, patient-level agreement may be insufficient for direct clinical decision-making.

The authors acknowledge several limitations: a small evidence base (6 cohorts, 127 attempted procedures), limited agreement data, and wide limits of agreement. Follow-up duration, funding, and conflicts of interest were not reported. Certainty of evidence was not reported.

In practice, EUS-PPG appears feasible and shows a strong association with invasive hemodynamic comparators, but further study is needed to establish patient-level agreement, reproducibility, and clinical thresholds. EUS-based measurements are not yet established as a direct replacement for HVPG for clinical decision-making.

Managing portal hypertension, a condition where blood pressure in the portal vein is too high, often requires invasive tests. These tests can be difficult for patients to undergo. Researchers looked at a newer method called EUS-PPG, which uses an endoscopic ultrasound to measure these pressure levels.

The study looked at 127 procedures across six different groups. The results showed a strong link between the ultrasound measurements and the traditional, more invasive tests. The procedure was successful about 95% of the time. While the ultrasound method shows a strong association with current standards, the data shows a wide range of agreement between the two methods.

It is important to note that the evidence base is still small. Because there is a wide range of agreement and limited data on how consistent the results are across different patients, this ultrasound method is not yet a direct replacement for standard tests. More research is needed to see if it can be used reliably for making clinical decisions.

What this means for you:
Ultrasound-based measurements show a strong link to standard liver pressure tests but need more study to be used alone.

Common questions

Is the ultrasound procedure safe for patients?

The procedure was reported to have a 2.4% rate of adverse events. Importantly, there were no procedure-related deaths reported in the study. You should talk to your doctor about the specific risks and benefits of this procedure for your situation.

How accurate is the ultrasound compared to standard tests?

The study found a strong association between the ultrasound measurements and standard invasive tests. However, the results showed a wide range of agreement between the two methods, and the evidence base is currently small.

Can this ultrasound method replace standard liver pressure tests?

Not yet. While the ultrasound method shows a strong link to standard tests, it is not currently established as a direct replacement for clinical decision-making. More research is needed to ensure it is consistent and reliable for every patient.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedOct 2026
View Original Abstract ↓
PURPOSE: Published reviews of endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) have emphasized feasibility and safety. We performed a systematic review and meta-analysis specifically to evaluate how closely EUS-based portal pressure measurements track invasive comparator measurements in prospective paired studies and to summarize agreement, technical success, and adverse events. METHODS: We searched major databases through January 2026 for prospective cohorts reporting same-patient EUS-based portal pressure measurement and invasive hemodynamic measurements. Correlations were pooled with random-effects models and analyzed separately for studies comparing EUS-PPG with hepatic venous pressure gradient (HVPG) and studies comparing EUS-based portal measurements with direct portal venous pressure. Agreement and threshold discordance were summarized descriptively. RESULTS: Six prospective cohorts (127 attempted procedures) were included. In studies using HVPG as the comparator, the pooled correlation was 0.82 (95% CI, 0.72-0.89; I = 0%). In studies comparing EUS-based portal measurements with direct portal venous pressure, the pooled correlation was 0.86 (95% CI, 0.72-0.93; I = 16.9%). Technical success was 95.3%. EUS-PPG-attributed adverse events occurred in 2.4% of procedures, with no procedure-related deaths. Agreement data were limited. Reported limits of agreement were wide (approximately - 6 to + 7 mmHg), and discrepancies of 5 mmHg or greater occurred in 4 of 30 paired measurements. CONCLUSIONS: EUS-based portal pressure measurement is feasible and shows a strong association with invasive hemodynamic comparators, but the evidence base remains small (six cohorts, 127 attempted procedures). Further study will be necessary to establish patient-level agreement, procedural reproducibility, EUS-specific clinically significant portal hypertension thresholds, and whether HVPG-based decision thresholds can be transferred to EUS-derived measurements.
Free Newsletter

Clinical research that matters. Delivered to your inbox.

Join thousands of clinicians and researchers. No spam, unsubscribe anytime.